PERSONAL DATA SHEET

WARNING: Any misinterpretation made in the Personal Data Sheet and the Work Experience Sheet shall cause the filing of administrative/criminal case/s against the person
concerned.
READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM.
Print legibly. Tick appropriate boxes ( ) and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE. 1. CS ID No. (Do not fill up. For CSC use only)

I. PERSONAL INFORMATION
2. SURNAME ALCOREZA
FIRST NAME JOSEPH
MIDDLE NAME ALVAREZ
3. DATE OF BIRTH
(mm/dd/yyyy) 04/09/119303/03/1989 16. CITIZENSHIP Filipino

4. PLACE OF BIRTH Lucena City If holder of dual citizenship, Pls. indicate country:
Male please indicate the details.
5. SEX

6 CIVIL STATUS Single

17. RESIDENTIAL ADDRESS RM 2027 TOWER 1 Madison street
House/Block/Lot No. Street
SM Light Residency Barangka Ilaya
Subdivision/Village Barangay

7. HEIGHT (m) 1.67 Mandaluyong City Metro Manila

City/Municipality Province
8. WEIGHT (kg) 92 ZIP CODE 1550
18. PERMANENT ADDRESS RM 2027 TOWER 1 Madison street
9. BLOOD TYPE B+
House/Block/Lot No. Street

10. GSIS ID NO. N/A SM Light Residency Barangka Ilaya

Subdivision/Village Barangay
11. PAG-IBIG ID NO. N/A
Mandaluyong City Metro Manila
12. PHILHEALTH NO. 160503110052 ZIP CODE City/Municipality Province

13. SSS NO. CRN-0111-3177871-B 19. TELEPHONE NO.

14. TIN NO. 2117692283 20. MOBILE NO. (63) 778 145 563
15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) alcorezaRRT@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME N/A N/A N/A

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME ALCOREZA

FIRST NAME RAUL September 09, 1958
MIDDLE NAME VOLPANE
25. MOTHER'S MAIDEN NAME

SURNAME ALVAREZ 9/9/1955

FIRST NAME SUSANA
MIDDLE NAME Ilagan (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

HIGHEST SCHOLARSHIP/
26. PERIOD OF ATTENDANCE LEVEL/ YEAR
NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE ACADEMIC
LEVEL UNITS EARNED
GRADUATE
HONORS
(Write in full) (Write in full) D
(if not graduated) RECEIVED
From To

Unisan Central Elementary June March

ELEMENTARY Primary 1995 2001
N/A 2001 N/A
School
June March
SECONDARY DOMINICAN ACADEMY High School 2001 2005
N/A 2005 N/A

VOCATIONAL /
TRADE COURSE N/A N/A N/A N/A N/A N/A N/A

CALAYAN EDUCATIONAL June April

COLLEGE BS Radiologic Technology N/A 2010 N/A
FOUNDATION INC> 2005 2010

GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE March 21, 2019

CS FORM 212 (Revised 2017), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF LICENSE (if applicable)
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER Date of
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity
June 15-
RADIOLOGIC TECHNOLOGIST 85.60% METRO MANILA 0011149 2019
16,2013

(Continue on separate sheet if necessary)

V. WORK EXPERIENCE
(Include private employment. Start from your recent work) Description of duties should be indicated in the attached Work Experience sheet.
28. INCLUSIVE DATES SALARY/ JOB/ PAY
(mm/dd/yyyy) GRADE (if GOV'T
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY STATUS OF
SERVICE
applicable)& STEP
(Write in full/Do not abbreviate) (Write in full/Do not abbreviate) SALARY (Format "00-0")/ APPOINTMENT
(Y/ N)
INCREMENT
From To

10/21/2017 Present Laboratory Technologist III UP-Philippine General Hospiral 22,990 N/A JOB ORDER YES

06/02/2013 03/29/2017 Radiologic Technologist FriendlyCare Clinic-Shaw 14,550 N/A REGULAR NO

11/05/201105/31/2012 Radiologic Technologist Quezon Medical Center 8755 N/A JOB YES
ORDER
07/10/201010/31/2011 Radiologic Technologist Lucena United Medical Center 8755 N/A Regular No
 (Continue on separate sheet if necessary)

SIGNATURE DATE March 21, 2019

CS FORM 212 (Revised 2017), Page 2 of 4

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
INCLUSIVE DATES
29. NAME & ADDRESS OF ORGANIZATION (Write in full)
(mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To

N/A

N/A

N/A

N/A

N/A

N/A

N/A
(Continue on separate sheet if necessary)
VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
(Start from the most recent L&D/training program and include only the relevant L&D/training taken for the last five (5) years for Division Chief/Executive/Managerial positions)

INCLUSIVE DATES OF Type of LD

30. ATTENDANCE
TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ( Managerial/CONDUCTED/ SPONSORED BY
(mm/dd/yyyy) NUMBER OF HOURS
(Write in full) Supervisory/ (Write in full)
Technical/etc)
From To

BASIC ECHOCARDIOGRAPHY FOR SONOGRAPHERS 2018 06/16/2018 08/25/2018 N/A N/A Philippine Society of Echocardiography

VASCULAR 101 "ABC to XYZ of Vascular Medicine" 05/22/2018 05/22/2018 N/A N/A Philippine Society of Vascular Medicine

3D Echo in Diagnosis and Intervention Workshop 03/21/2018 03/21/2018 N/A N/A Philippine Society of Echocardiography

Vascular Chi: A Collaborative,Holistic,Intergrative Approach to Vascular Diseases 10/26/2017 10/27/2017 N/A N/A Philippine Society of Vascular Medicine

Echocardiography Workshop on Congenital Heart Disease 10/14/2017 10/14/2017 N/A N/A Philippine Society of Vascular Medicine

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

 NON-ACADEMIC DISTINCTIONS / RECOGNITION MEMBERSHIP IN ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full) (Write in full)

Reading, Watching TV N/A PHILIPPINE SOCIETY OF

ECHOCARDIOGRAPHY
PHILIPPINE ASSOCIATION OF
RADIOLOGIC TECHNOLOGIST

(Continue on separate sheet if necessary)

SIGNATURE DATE March 21, 2019

CS FORM 212 (Revised 2017), Page 3 of 4
34. Are you related by consanguinity or affinity to the appointing or recommending authority, or to the
chief of bureau or office or to the person who has immediate supervision over you in the Office,
Bureau or Department where you will be apppointed,
a. within the third degree?
b. within the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details:
________________________________
________________________________

35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court?
If YES, give details:
________________________________
Date Filed:
________________________________
Status of Case/s:
36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or
regulation by any court or tribunal?
If YES, give details:
________________________________
________________________________
37. Have you ever been separated from the service in any of the following modes: resignation,
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or phased If YES, give details: completion of residency
out (abolition) in the public or private sector?

38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the
last election to promote/actively campaign for a national or local candidate? If YES, give details:

39. Have you acquired the status of an immigrant or permanent resident of another country?
If YES, give details (country):

40. Pursuant to: (a) Indigenous People's Act (RA 8371); (b) Magna Carta for Disabled Persons (RA
7277); and (c) Solo Parents Welfare Act of 2000 (RA 8972), please answer the following items:
a Are you a member of any indigenous group?
.
If YES, please specify:
b Are you a person with disability?
.
If YES, please specify ID No:
c Are you a solo parent?
.
If YES, please specify ID No:

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

NAME ADDRESS TEL. NO.

Edgard Foronda M.D. Tricity Medical Center (63)9176226732

Dante Perez M.D. Tricity Medical Center (63)9983809365

Nerea Pamintuan M.D. FriendlyCare Clinic (63)9166488745

42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete statement pursuant to the provisions of pertinent laws, rul

PHOTO
Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.)
PLEASE INDICATE ID Number and Date of Issuance
Government Issued ID: PRC ID

ID/License/Passport No.: 0011149 Signature (Sign inside the box)

12/21/2018
Date/Place of Issuance: 7/1/2013 Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.

Person Administering Oath

CS FORM 212 (Revised 2017), Page 4 of 4